Cervical Stenosis

What Is It?

Cervical stenosis is a narrowing of the spinal canal which protects the spinal cord. Spinal stenosis can occur in many areas but is most commonly found in the cervical spine and in the lumbar spine.

Cervical stenosis typically results from degenerative changes that occur in the spine over years, due to aging and wear and tear. Over time, cervical disc herniations, inflammation and overgrowth of soft tissues and ligaments, and overgrowth of bone (osteophytes) can build up on the spine. This excess and bulging tissue can eventually start to compromise the normal space within the spinal canal. If it becomes severe enough, this narrowing of the canal can begin to compress the nervous system structures including the spinal nerves and even the spinal cord itself.

What Types of Symptoms Are Typical?

Cervical stenosis can cause neck pain, but much more frequently it presents with symptoms in the arms. The symptoms can be in only one arm or both and can include muscle weakness, numbness and tingling and/or pain, often in multiple distributions of the arms.

As stenosis becomes more severe, the spinal cord itself can become compressed, leading to a different set of symptoms. Muscle weakness becomes spastic, with increased reflexes and poor motor control. It can also affect the legs and bowel and bladder function at this point.

Rarely, spinal stenosis in the cervical spine may make itself known only after a traumatic injury which causes rapid bending of the neck. The stenosis in this case can lead to a pinching of the spinal cord which can lead to an acute worsening of symptoms, usually worse in the arms than in the legs. This type of traumatic spine injury can cause what is termed central cord syndrome.

How Is The Diagnosis Typically Made?

Patients who present with symptoms suggestive of cervical stenosis are usually worked up with a neurological evaluation and a CT scan or MRI scan. An MRI scan is particularly good at evaluating the spinal canal, the spinal cord and the nerves coming and going from the spine. Associated pathologies can also be seen and other diagnoses, such as a tumor or a cervical herniated disc, can be ruled out.

Occasionally tests such as a nerve conduction study may be performed to evaluate the function of the nerves and to determine which nerve root levels are most affected and may benefit from surgery or other treatments.

What Are Some Common Treatments?

The treatment of cervical stenosis is highly individualized depending on the specifics of each case. In mild cases, simple rest, physical therapy, anti-inflammatory medications or spinal injections may be sufficient to reduce symptoms. However, for some patients with more severe disease or who fail these conservative measures, surgery may be recommended. The specific type of surgery depends on the specific anatomical characteristics and symptomatology of each case.

One of the common procedures used for stenosis is a laminectomy, removal of the posterior part of the spine bone and soft tissues to open up the canal and give the spinal cord and nerve roots more room. The number of levels opened in a laminectomy depends on the length of stenosis. In some cases a fusion with metal screws and rods will be performed at the same time or at a latter date.

In some cases in which the stenosis is primarily anterior an anterior approach through the neck will be used to decompress and fuse the spine.

Finally, because compression of the nerves in the foramina (foraminal stenosis), the openings through which nerves pass from the spine, can often occur concurrently with cervical stenosis, foramenotomies at the affected levels in addition to one of the above procedures may also help to decrease nerve compression and improve symptoms.

Each case and patient is different. Therefore, treatment decisions should be made with each patient's own treating physician.

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